Leveraging School-Based Health Services for Children with Medicaid/CHIP Coverage

Medicaid and CHIP School Medicaid and CHIP School- -Based Health Services Affinity Group Health Services Affinity Group Based Healthy Students Promising Futures Liz Clark, Center for Medicaid and CHIP Services, Division of Quality and Health Outcomes December 4-5, 2018

Participating State Medicaid Agencies Participating State Medicaid Agencies Arkansas Colorado Idaho Michigan Nebraska New Jersey North Carolina Ohio Goal: To improve access to care and health outcomes for children and adolescents with Medicaid or CHIP coverage by leveraging schools as settings for care 12 months Voluntary No funding Medicaid/CHIP primary applicant State-directed content 2

Arkansas Arkansas Worked to promote better billing through Medicaid Coding Planned to provide designated Arkansas Department of Education employees with limited access to Medicaid Management Information System ( MMIS) to directly assist school employees with Medicaid claims questions Began discussions with University of Arkansas Medical School to provide training to school-based personnel for proper Medicaid coding Initiated development of stand-alone Medicaid manual school-based services, procedures and diagnoses Focused on Access to Care New Medicaid Telemedicine rule approved by Arkansas Legislature (Effective 8/1/18; retroactive to 4/10/18) Considering additional opportunities 3

Colorado Colorado Produced a plan to pilot Regional Accountability Entity/District partnerships Full support across state and nonprofit partners Leveraging existing resources Developed ongoing Medicaid data projects Comprehensive child health data dashboard, integrating existing delivery system measures Medicaid-led health/education data sharing strategy Launched third phase of School Health Services free care research Based on CMS communications facilitated by this affinity group 4

Idaho Idaho Data Sharing and Health Information Technology Issues Successful collaboration between State Department of Education and Division of Medicaid Updating the Memorandum of Understanding between the agencies Optional free Statewide IEP system for school districts and charter schools Care Coordination and Access Increased competency and services delivered in schools Workgroup for Behavioral Health standardized screening and risk tool Core Measure Improvement Coordination of Healthy Connection PCPs and school nurses Weekly visits with one School-Based Health Center to learn best practices and expand the knowledge with other school districts 5

Michigan Michigan Free Care Behavioral/Mental Health Services Determined that there were viable opportunities for expanding services to general education students Collaborated with other State programs Nursing Services Identified opportunities to increase services to all students School-Based Medical Home Model of Care Explored but Opted for an Alternate Model of Care 6

Nebraska Nebraska Conducted a state-wide survey of schools 39.8% indicated their schools work with community partners to facilitate mental and behavioral health (MBH) referrals for students. 75.24% do not believe there are adequate community resources available within a range of 25 miles to serve students with MBH issues. When students have MBH issues, 61.44% of schools inquire about a recent medical visit, 41.69% inquire about a vision checkup, and 31.03% inquire about a dental visit. (Physical, visual, or dental issues all can be implicated in a child s behavior.) Created Why Health Insurance is Important for Your Child communication piece, which was translated into several languages. Organized Healthy Youth Nebraska Conference, Addressing Risks, Resiliency and Barriers to Success for 144 professionals. Created a map for Nebraska Public School Districts and agencies across NE to help identify tele-behavioral health resources. Developed Cross-Division Relationships within Department of HHS. 7

New Jersey New Jersey Initiated discussions on crafting NJ licensure standards for School-Based Health Centers Reviewing initiatives from other States Collaboration between community partners, the NJ Dept. of Health, Dept. Human Services and Dept. of Child and Family Services Determining physical plant limitations NJ DOH Regulatory Committee participation Explored Leveraging Managed Care Organizations Ongoing discussions with MCO Medical Directors MCO Receptiveness Augmenting Networks Ongoing Discussions Pursued Potential Partnerships with School Based Health Centers Hospitals Federally Qualified Health Centers Worked to Address Active Immunization Issues Vaccines for Children (VFC) programmatic challenges Vaccine storage and provider suspensions Data logger mandate Vaccine Transport Provider VFC participation 8

North Carolina North Carolina Used the monthly TA calls to inform the development of State Plan Amendments (SPAs) to improve access to care for children with specialized needs. Worked on developing SPAs to address the following areas: Transportation services Personal care services Case management/Targeted Case Management 9

Ohio Ohio Created and distributed a SBHC Toolkit Help schools develop locally focused SBHCs by giving examples of success already found in Ohio Ohio PCP model for partnering schools and medical practices Included health factors in ODE Agency goals Dedicated position to help with SBHC day-to-day activities ODE restructure to highlight school health and better incorporate health issues into larger agency framework Created an Ohio School Health Collaborative Ongoing state/local meetings to discuss issues and develop results Use of data to address known issues of mental health, asthma, and diabetes 10

Questions Questions Please contact: Liz Clark, CMS Elizabeth.clark@cms.hhs.gov